The morbidity and mortality associated with ischemic heart disease (IHD) is substantial. Within 5 years after a first myocardial infarction, 33% of men and 43% of women die (1). In addition, IHD is responsible for direct and indirect costs of approximately $156.4 billion annually (1). Considering the significant impact of IHD, strategies to predict and prevent cardiovascular events in individuals with IHD are imperative. The development of new high-sensitivity assays for measurement of cardiac troponin has opened a window for studying the impact of very small elevations of cardiac troponin on cardiovascular disease outcomes (2). This study proposes to evaluate the relationship between high-sensitivity cardiac Troponin T (hs-cTnT) and cardiovascular outcomes in subjects from the Heart and Soul Study, a longitudinal cohort study of 1024 subjects with chronic IHD. Patients were recruited between 9/00-12/02, and have been followed since then for cardiovascular outcomes including myocardial infarction, heart failure, stroke, cardiac death, and all-cause mortality. High-sensitivity cardiac Troponin T will be measured from baseline samples as well as samples obtained after 5 years of follow-up from 660 participants (>80% of survivors) within the Heart and Soul Study cohort. In Aim 1, the study will determine the association between baseline hs-cTnT and cardiovascular events in participants with chronic IHD by performing multivariate analysis with adjustment for baseline characteristics. In Aim 2, the study will evaluate the prognostic value of using hs-cTnT in addition to basic clinical measures by comparing discrimination (C statistic), calibration, and Net Reclassification Improvement (NRI) for predictive models with and without hs-cTnT. In Aim 3, the study will determine the association between 5 year change in hs-cTnT and 5-year change in cardiac structure and function. The information gained from this investigation will help to refine methods for predicting future cardiovascular events in individuals with chronic IHD. In addition to training in clinical research through the conduct of the study, the applicant will undertake didactic instruction in epidemiologic and biostatistical methods through the well-established Masters Degree Program in Clinical Research at the University of California, San Francisco. PUBLIC HEALTH RELEVANCE: Each year, approximately 770,000 Americans will have a first ischemic heart disease event and 430,000 will have a recurrent event (1). Improved strategies to predict and prevent future cardiovascular events and death in these individuals are needed. This research will determine whether measurement of a novel biomarker, high-sensitivity cardiac Troponin T, in individuals with chronic ischemic heart disease predicts future cardiovascular events, which will serve to refine our ability to predict and prevent events in this population.